Title: Child Abuse and Neglect: Recognizing, Reporting, and Responding in Early Childhood
1Child Abuse and NeglectRecognizing, Reporting,
and Responding in Early Childhood
- Ally Burr-Harris, Ph.D.
- Greater St. Louis Child Traumatic Stress Program
- Center for Trauma Recovery
- University of Missouri-St. Louis
- Revised 10/6/04
2Greater St. Louis Child Traumatic Stress Program
- Member of National Child Traumatic Stress Network
(NCTSN)-www.nctsnet.org - Services provided by Childrens Advocacy Center
and Center for Trauma Recovery at UMSL - Free assessment and treatment of children and
adolescents who have experienced a trauma - Consultation and training of education, mental
health, and medical professionals in the area of
child trauma - School-based group therapy for children and
adolescents exposed to violence
3(No Transcript)
4What is Child Abuse and Neglect?
- Missouri Child Abuse Law definitions
- ABUSE Any physical injury, sexual abuse, or
emotional abuse inflicted on a child other than
by accidental means by those responsible for the
childs care, custody and control except that
discipline including spanking, administered in a
reasonable manner shall not be construed to be
abuse - NEGLECT Failure to provide, by those responsible
for the care, custody, and control of the child,
the proper or necessary support, education as
required by law, nutrition or medical, surgical,
or any other care necessary for the childs
well-being.
5Physical Abuse
- Pinching
- Squeezing
- Pushing
- Shaking
- Cornering
- Restraining
- Striking
- Throwing things
- Breaking bones
- Internal injuries
- Using weapons
- Burning
- Disabling
- Disfiguring
- Maiming
- Murdering
6Sexual Abuse
- Sexual talk or correspondence
- Voyeurism
- Child prostitution, child pornography
- Exhibitionism (e.g., exposure to adult genitalia,
adult sexual acts, pornography) - Molestation (e.g., touching, fondling or kissing
child for adults sexual gratification) - Coerced sexual activity
- Consensual sexual activity between minor and
significantly older person - Sexual penetration (digital, object, genitalia)
- Rape
7Physical Neglect
- Refusal/delay in medical attention and care
- Abandonment
- Expulsion from home without adequate care
- Inadequate supervision
- Failure to provide for basic needs of child
(e.g., food, clothing, shelter, hygiene) - Failure to thrive (FTT)
8Emotional/Educational Neglect
- Refusal/delay of needed psychological care
- Failure to enroll permitted chronic truancy
- Failure to access special education services
- Permitting criminal behavior
- Allowing child to abuse drugs
- Exposure to domestic violence
9Emotional Abuse
- Verbal abuse (e.g., demeaning, ridiculing)
- Inadequate nurturance/affection
- Substance/alcohol abuse of caregiver
- Threats
- Extreme rejection
- Corruption, exploitation, brainwashing
- Cruel punishments
10Incidence and Types of Child Maltreatment
11Incidence of Child Abuse Neglect General
- U.S. Dept. of Health Human Services
- In 2001, 3 million children were subjects of
abuse/neglect investigations and approximately
903,000 children were found to be victims of
substantiated abuse/neglect - Missouri Division of Family Services
- In 2002, 83,441 children were the subjects of an
abuse/neglect investigation in Missouri, and 9802
children were found to be victims of
substantiated abuse/neglect
12Incidence of Physical Abuse
- Nationwide, 18.6 of substantiated victims in
2001 were physically abused - In Missouri, 25.4 of substantiated victims in
2002 were physically abused - Rate of physically abused children meeting Harm
Standard has increased nationwide over last
decade
13Incidence of Sexual Abuse
- Nationwide, 9.6 of substantiated victims in 2001
were sexually abused - In Missouri, 25.5 of substantiated victims in
2002 were sexually abused - Nationwide, there has been a 40 decline in the
estimated number of child sexual abuse
substantiations since 1992 - A nationwide survey of adults found that about 1
in 4 women and 1 in 6 men experienced some form
of sexual abuse by age 18 (Finkelhor, 1990)
14Incidence of Neglect
- Most common type of reported and substantiated
maltreatment - Nationwide, 59.2 of substantiated victims in
2001 suffered neglect - In Missouri, 44 of substantiated victims in 2002
experienced physical neglect - Estimated number of physically neglected children
meeting the Harm Standard rose 102 from 1986 to
1993
15Incidence of Emotional Abuse
- Nationwide, 6.8 of substantiated victims in 2001
were emotionally abused - In Missouri, 5.6 of substantiated victims
experienced emotional maltreatment - The estimated number of emotionally neglected
children meeting the Harm Standard rose 333 from
1986 to 1993 - One study found 68 of wife assault cases
involved the presence of children (Leighton,
1989)
16Risk Factors for Abuse/Neglect Child Factors
- Gender - girls
- Age - under 3 yrs
- Difficult temperament
- Disabilities
- Behavioral difficulties
- Chronic illness
17Risk Factors for Abuse/NeglectCaregiver Factors
- History of Abuse
- Anger difficulties
- Poor impulse control
- Psychiatric disorders
- Substance abuse
- Social isolation
- Personal distress
- Unrealistic expectations
- Negative view of child
- Parent chronic illness
- Poor parenting skills
- Male
- Young age
18Characteristics Risk FactorsFamily Environment
- Single-parent families
- Blended families
- Poverty
- Domestic violence
- Family crises
- Chaos/instability
- Housing problems
- Social isolation
- Family size (neglect)
19Protective Factors for Abuse/Neglect
- Caregiver parenting skills
- Community support of families
- Availability of emotional, social, and financial
support for families - Stable housing
- Connection to community, faith-based
organizations - Good personal safety skills for children
- Easy access to health care, childcare, etc.
- Wholesome environment
20Possible Signs of Physical Abuse
- Bruises, welts, burns, fractures, cuts
abrasions - Injuries to multiple body areas
- Various stages of healing
- Wearing clothes to cover injuries
- Reluctance to seek medical help (refuses medical
tests) - Extensive history of injury (frequent hospital
visits) - Inconsistent/unbelievable explanation of injury
- Excessive fear (or anticipation) of punishment
- Excessive fear of caregiver
- Regression (e.g., toileting)
- Wary of physical contact
- Frequent school absences
- Running away
- Child disclosure
21Possible Signs of Sexual Abuse
- Difficulty walking or sitting
- Vaginal, penile, rectal pain/discharge/bleeding
- Sudden refusal to change for gym or to
participate in physical activities - Inappropriate sexual knowledge/behavior
- Regression (e.g., toileting)
- Frequent urinary tract/vaginal infections, STD
- Wary of physical contact
- Abnormal fears about bodily functions
- Abnormal anogenital exam findings
- Child disclosure
22Possible Signs of Physical Neglect
- Frequent absences from school
- Begs, steals, hoards food/money/small items
- Lacks needed medical, visual or dental care
- Consistently dirty, poor hygiene
- Insufficient or ragged clothing
- Child abuses alcohol or other drugs
- Malnourished, thin, constant hunger
- Tired, falls asleep (other than nap) during day
- Child anticipates being left unattended (e.g., in
car) - Small for age - FTT
- Chaotic home environment
- Serious caregiver problems
- Lack of supervision
- Chronic ailments
- Child disclosure
23Possible Signs of Emotional Abuse/Neglect
- Extreme behaviors (e.g., passive-violent) in
child - Developmental delays
- Child very fearful of being punished
- School absence or non-enrollment
- Chaotic home environment (frequent moves)
- Serious caregiver problems
- Caregiver disinterested in or unresponsive to
child - Unusual, harsh, demeaning punishments of child
- Withdrawal, passivity, apathy
- Significant change in behavior
- Pseudomature behavior
- Child disclosure
24General Indicators That Something Is Wrong
- Anger/irritability
- Increase in crying, difficult to comfort
- Symptoms of depression/anxiety
- Sudden changes in behavior
- Sudden changes in sleep/appetite
- Sudden changes in school performance
- Loss of interest/social withdrawal
- Self-destructive behaviors
- Loss of energy
- Difficulty concentrating/attending
- Sudden change in activity level
- New fears
- Consistent reluctance to leave with caretaker
25Impact of Abuse Neglect
26Predictors of Trauma Effects
- Low IQ
- Female
- Younger age
- Passive coping
- Limited support
- Unsupportive caregiver
- Severity/chronicity of abuse
- High abuse-related stress
- Relationship to abuser
- Use of threat
27Extent of CAN Effects
- 40-60 have emotional/behavior problems
- 1 predictor of substance abuse in women
- Decreases IQ
- Alters brain development
- gt50 have school problems
- gt25 require SSD services
28Growth of the Human Brain from birth to 20 years
7 years
29Normal Brain Development Age 5 20 Years
30Trauma SymptomsInfants and Toddlers
- Pattern A Withdraws, rejects affection, stops
exploring environment, lacks trust in others,
appears unattachedPattern B Clingy, anxious,
sleep disturbances, toileting problems, temper
tantrums, regressed, disorganized,
rages/aggression, crying irritability
31Trauma Symptoms Preschoolers
- Regressive behaviors
- Separation fears
- Eating and sleeping disturbances
- Physical aches and pains
- Crying/irritability
- Appearing frozen or moving aimlessly
- Perseverative, ritualistic play
- Reenactment of trauma themes
- Fearful avoidance and phobic reactions
- Magical thinking related to trauma
- Poor concentration, difficulty learning
- Behavior problems (e.g., tantrums)
32Trauma Symptoms Elementary School-Age
- Sadness, crying
- Irritability, aggression
- Nightmares
- Trauma themes in play/art/conversation
- School avoidance
- Behavior/academic problems
- Physical complaints
- Concentration problems
- Regressive behavior
- Eating/sleeping changes
- Attention-seeking behavior
- Withdrawal
33Impact of Physical Abuse
- Aggression, reactive anger
- Oppositional behavior
- Social immaturity
- Attachment problems
- Posttraumatic stress
- Violent play
- Developmental delays
- Neurological impairment
- Poor problem-solving
- Physical injury, death
34Impact of Sexual Abuse
- Sexualized behavior, play
- Promiscuity
- Posttraumatic stress
- Nightmares
- Regression
- Somatic complaints
- Poor self-esteem
- Self-destructive behaviors
- Poor interpersonal boundaries
- Resists affection
- Physical injury
- Withdrawal
35Impact of Neglect
- Cognitive/academic deficits
- Language deficits
- Developmental delays
- Social withdrawal
- Decreased moral development
- Stealing, lying, hoarding
- Insecure or disorganized attachment
- Emotional volatility
- Retarded physical growth
- Death
36Impact of Emotional Abuse
- Extreme behaviors
- Developmental delays
- Overly compliant
- Self-critical
- Flat, negative affect
- Passive, dependent
- Self-destructive behaviors
- Antisocial/violent behaviors
- Indiscriminately friendly
- Poor social skills
- Pseudomature behavior
- Attachment disorders
37Reporting Suspected Child Abuse/Neglect
- You are required to report abuse if you have
reasonable cause to suspect that a child has been
or may be subjected to abuse or neglect or if you
observe a child subjected to these conditions - As a mandated reporter, failure to report is a
misdemeanor that could result in a fine or jail
time, loss of professional license, and possible
civil suits - Err on the side of reporting
- You can call hotline anonymously and describe
situation first to determine if you are required
to report the incident. Must identify self when
making hotline as mandated reporter.
38Numbers to Call
- Missouri Hotline 1-800-392-3738
- (St. Louis County DFS 314-877-3030)
- Persons calling from outside Missouri should dial
573-751-3448 - Text telephone number 1-800-669-8689
- Illinois Hotline 773-734-4033
- National hotline 1-800-422-4453
- For other states check
- http//www.childhelpusa.org/child/report/htm
39Information for the Report
- Name of the child and parent(s)
- Contact information for child (must have this)
- Name of the alleged abuser and contact
information if available - Any immediate or continued risk for harm?
- Extent of injuries
- Details of abuse/neglect (dates, times)
- Any abuse/neglect witnessed?
- Other witnesses and their contact information
40After a Report
- Report sent to appropriate DFS county office
http//www.dss.state.mo.us/dfs/county.htm - Investigation by DFS social worker initiated
within 24 hours of the receipt of the report (72
hours if educational neglect). - Possible outcomes
- Investigation
- Family assessment and services
- Probable cause
- Unsubstantiated - Preventive services indicated
- Unsubstantiated
41Helping Abused/Neglected Children
- Provide realistic reassurance of safety and
security - Allow child to be more dependent temporarily if
needed - Follow childs lead (hugs, listening, support)
- Use typical soothing behaviors
- Use security items and goodbye rituals to ease
separation from caregiver - Distract with pleasurable activities
- Let child know you care
- Maintain normal routines when possible
- Avoid exposing child to unnecessary reminders of
the abuse
42Helping Abused/Neglected Children (cont.)
- Minimize contact with others who upset child
- Continue to set limits for inappropriate behavior
as needed - Anticipate temporary increase in problem
behaviors - Identify antecedents of problem behaviors and
develop behavior management plan - Redirect/Stop abuse reenactment play as needed
- Facilitate resolution of abuse themes in play/art
if possible - Assist child in coping with trauma reminders
- Attempt to alter negative association with
nonharmful trauma cues
43Discussing Abuse/Neglect with Children
- Do not ask leading questions, particularly if
investigation is underway - Do not over-interview or bias childs report
- Encourage child to express abusive experience but
dont pressure - Emphasize childs safety now
- Praise child for telling encourage honesty
- Be an active listener
- Remain calm when answering questions and use
simple, direct terms
44Discussing Abuse/Neglect with Children (cont.)
- Dont soften information you give to child
- Help child develop a realistic understanding of
what happened - Gently correct abuse-related distortions
- Be willing to repeat yourself
- Tolerate retellings
- Protect other children from exposure to trauma
retellings/reenactments - Normalize bad feelings or symptoms
45Helping Non-Offending Parents of Abused/Neglected
Children
- Communicate with parents about the child
- Encourage parents to listen to child closely
- Encourage parents to set aside special time for
child - Recommend maintenance of normal routine
- Encourage parents to remain calm and get help for
themselves if needed - Educate parents regarding importance of
responding supportively - Normalize childs difficulties
46Helping Non-Offending Parents of Abused/Neglected
Children
- Model soothing behaviors with younger children
- Assist in developing plan for behavior mgmt.
- Guide foster parent in getting to know child
- Advocate for continuity of school placement if
child is placed out of home - Equip parents with good skills through workshops,
references, modeling - Encourage parent involvement in classroom
47Helping Potentially Abusive/Neglectful Parents
- Gently point out concerns by focusing on
observable facts and behaviors - Offer assistance, support, resources
- Do not hypothesize, stick to observable facts
- Acknowledge parents strengths, efforts
- Focus concern on childs welfare and present as
common concern - Model effective parenting skills
- Catch parent doing well reinforce successes
- Dont get caught in triangles with parents
48When to Refer for Psychological Care
- Appear depressed, withdrawn
- Strong resistance to affection or support from
caregivers - Suicidal or homicidal ideation
- Dangerous behaviors to self/others
- Increased usage of alcohol or drugs
- Rapid weight gain/loss
- Significant behavioral change
- Poor hygiene
- Significant acute stress symptoms (e.g.,
nightmares, startle easily, hypervigilance)
49When to Refer for Psychological Care
- Intense anxiety or avoidance behavior if reminded
of abuse - Inappropriate social behaviors
- Unable to regulate emotions
- Poor academic performance and decreased
concentration - Continued worry about the abuse (primary focus)
- Intense separation difficulties
- Persistent physical complaints (nausea,
headaches) - Continued abuse themes in play, art,
conversation, behavior - Sexualized behavior
50Were Done!
- For additional questions, referrals, or
references, contact Dr. Ally Burr-Harris - E-mail Burrharrisa_at_msx.umsl.edu
- Phone
- (314) 516-5440